Labour

Question 1

What is labour?

Answer 1

Onset of regular and painful contractions associated with cervical dilation and descent of presenting part

Question 2

When does normal labour occur? What does this result in?

Answer 2

After 37 weeks and results in spontaneous vaginal delivery of baby within 24h of onset of regular spontaneous contractions.

Question 3

What often precedes labour?

Answer 3

A ‘show’

Plug of cervical mucus and a little blood as the membranes strip from the os

Question 4

What are signs of labour?

Answer 4

Regular and painful uterine contractions
A show - shedding of mucus plug
Rupture of membranes (not always)
Shortening and dilation of the cervix

Question 5

What are the stages of labour?

Answer 5

1. from the onset of true labour to when cervix is fully dilated: cervix dilates and head flexes further and descends into pelvis
2. full dilation to delivery of the fetus
3. from delivery of fetus to when the placenta and membranes have been completely delivered

Question 6

Describe the latent phase of first stage of labour

Answer 6

Latent phase:
Painful, often irregular contractions
Cervix initially effaces (becomes shorter and softer) then dilates to 4cm

Question 7

Describe the established phase of first stage of labour

Answer 7

Regular contraction with dilatation from 4cm

Question 8

What is a satisfactory rate of cervical dilatation in the established phase?

Answer 8

0.5cm/h

Question 9

How long does the first stage take?

Answer 9

8-18h in primp

5-12h in multip

Question 10

What should you do during first stage of labour?

Answer 10

Check maternal BP and temperature 4 hourly
Pulse hourly
Assess the contractions every 30 minutes
- strength
- frequency (ideally 3-4 per 10 minutes, lasting up to 1 minute)
Note frequency of bladder emptying
Offer vaginal examination to assess the degree of cervical dilatation, position and station of the head (cm above/below ischial spines)
Degree of moulding and caput
Note state of liquor
Auscultate fealty heart rate eery 15 minutes

Question 11

What is the passive stage in the second stage?

Answer 11

Complete cervical dilatation but no pushing

Seen in women with epidural where 1-2 hours of passive stage is recommended to reduce instrumental delivery rate.

Question 12

What is active stage of second stage?

Answer 12

Maternal pushing uses abdominal muscles and the Valsava manoeuvre until the baby is born

Question 13

What should you do in second stage?

Answer 13

Discourage supine maternal position
Check BP and pulse hourly
Check temperature 4 hourly
Assess contraction half hourly
Auscultate for 1 min after a contraction
Offer vaginal examination hourly
Record urination durgin 2nd stage

Question 14

What is required if contractions wane in second stage?

Answer 14

Oxytocin augmentation

Question 15

Describe the third stage of labour

Answer 15

Delivery of the placenta
As the uterus contracts to a <24 weeks size after baby is born, the placenta separates from the uterus through the spongy layer of the decider basalts
It then buckles and a small amount of retroplacental haemorrhage aids its removal

Question 16

What are signs of placenta separation in stage three?

Answer 16

Cord lengthening
Rush of blood (retroplacental haemorrhage) PV
Uterus rises
Uterus contracts in the abdomen (felt with hand as globular mass)

Takes < 1 hour

Question 17

What can be given to decrease third stage time and reduce incidence of PPH?

Answer 17

Syntometrine
Ergometrine maleate + oxytocin
As the anterior shoulder is born

CI in pre-eclampsia, sever HTN, severe liver or renal impairment and heart disease

• just give oxytocin

Question 18

Describe the passage of the baby

Answer 18

1.
Head descends into pelvis

2.
Head rotates at the levels of the ischial spin so the occiput lies in the anterior part of pelvis
Head broaches vulval ring (crowning and the perineum stretches over head)
Head is born
Anterior shoulder is born
Shoulders rotate to lie in the AP diameter of the pelvic outlet
Head roatates externally to its direction at onset of labour

Downward and backward traction fo the head by the birth attendant aids delivery of the anterior shoulder

Birth fo the posterior shoulder is aided by lifting the head upwards while maintaining traction